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Four medical students from UNM are finishing up their Practical Immersion Experience in Ruidoso. The program is both a requirement and opportunity for students to work in a rural clinical practice. Students work a minimum of five half-days a week in a clinic and another five half-days participating in learning activities and developing a community project.

Three of the students, Stephanie Briones, Justin Ocksrider and Yana Zemkova recently sat down to talk about their observations and impressions of their six weeks working with local physicians.

They are all from Albuquerque and are between their first and second years in medical schools. No one has a firm idea of what they may specialize in.

"I'm trying to keep an open mind," Ocksrider said. "Most people decide in the third and fourth years when they go on rotations. Then you realize what you like and what you are good at. I'm trying not to be dead set on any one thing because I may change my mind."

Ocksrider left the state for his undergraduate work, eventually earning a Master's degree in Global Medicine from the University of Southern California. He is working with Dr. Arlene Brown.

Among the surprises he has experienced is how busy he has been here.

"I thought: 'Okay, I'm going to Ruidoso, a small, laid back place,'" Ocksrider said. "'I'll see a couple of people a day and then it will be quiet.' That is not the case at all. We see a ton of patients. There is a real need here, and it's not just Ruidoso. It's the surrounding areas and southern New Mexico, in general."

Another surprise was the type of work physicians are required to do.

"Because it is rural area and there are so few doctors, Dr. Brown is forced to have more responsibilities and do more," Ocksrider said. "A lot of doctors who practice where there are many resources pass certain jobs on to someone else, but not here. It's cool to see such a broad scope being done by a family doctor."

Yana Zemkova agreed.

"That's what is appealing to us because we want to be able to do that same kind of variety," Zemkova said. "You can do so much more in this environment. We want eventually to be able to incorporate that into our practices."

Zemkova is working with Dr. Michael Clements. She views herself as a traditional student, having done her undergraduate work in biology and Spanish.

"I love that all the patients have such a close relationship with the doctors," said Zemkova. "They become family friends. Dr. Clements has known his patients for 10 or 15 years. He knows the ins-and-outs of their care, and I think that is the kind of doctor we all want to be. We don't see that in Albuquerque, because, up there, everything is so quick and there are so many doctors a patient can choose. Here, there are fewer doctors so relationships are developed quicker and become more meaningful."

That the patient-physician relationship is stressed so early in their program has important ramifications for how these students will approach the rest of their schooling.

"From what I've gleaned from friends in other medical schools, the first time they get to talk to a patient is in their third year when they do their rotations," Ocksrider said. "I think the trend in medical schools is to move towards having students talk to patients, take their histories and perform physicals earlier on. UNM is great because we are talking to patients from the get-go. So, even though we have only one year of medical school, we feel confident knocking on a door and doing our job. Having the early experience is really helpful, and I think it will give us more confidence going into our rotations come our third and fourth year."

For Zemkova, the clinical aspect so early helps to tie everything together.

"In the classroom, we learn the hard facts," Zemkova said. "We learn how the heart works and the science behind it, but having this experience puts the patient into the equation. Now we can put all of that information that we've learned and apply it to a patient as well as understanding how it relates to what we will be doing. It's not just about learning facts."

As more of a non-traditional student, Stephanie Briones views the experience from a different perspective.

"My undergraduate degree is in business management; not a traditional major for those going into medical school," Briones said. "During the past year, because it was so grueling, I lost sight of why I was going to medical school. I asked myself: 'Why am I subjecting myself to this torture?' But then, given the experience of working with patients and putting what I've learned into practice, the question of why disappears. I can appreciate all of the hard work I've put in. I also recognize the effort and the dedication it takes to go along this path. It's a difficult one and it should be. We are dealing with lives. No one wants a doctor who had it easy through medical school."

Briones is working with Dr. Stephen Otero in the Lincoln County Medical Center building across from the hospital.

The proximity to the hospital allows Briones to see how specialists come into play.

"I was impressed by the variety of things treated over there," Briones said. "I figured that patients would be taken to Albuquerque or Las Cruces more often and that more serious cases would automatically be treated elsewhere. Having specialists come here on a regular basis makes it so much easier for patients in Ruidoso. They don't have to worry about traveling long distances or coming up with the means to stay somewhere else."

"Being outside of a large city does it make it more difficult to schedule appointments if you need a specialist," Zemkova added, "But even if specialists are not here on a permanent basis, they are still available."

Availability issues, however, do arise when practicing in a smaller town. Finding affordable housing and reliable wi-fi are two such hurdles the students faced this summer.

"Many people didn't want to rent for longer periods and those who did were out of our budget," Zemkova said.

Still, the experience allowed Briones, Ocksrider and Zemkova a taste of what life is like outside of Albuquerque.

"I hadn't considered going to a rural area before this experience because I like the small big-city of Albuquerque," Briones said. "I don't know if I could choose any rural area in New Mexico, but I could choose this area."

As part of the Practical Immersion Experience, the students will be hosting a free workshop on Chest Compression-Only CPR Thursday beginning at 6 p.m. at the Ruidoso Community Center. According to October 6, 2010 issue of The Journal of the American Medical Association, adults who experienced cardiac arrest in a non-hospital setting, such as a restaurant or at home, were 60% more likely to survive if they received compression-only CPR than if they received traditional CPR or no CPR until an emergency medical services (EMS) crew arrived at the scene. The workshop is informational; it is not a certification class. It is meant to address what bystanders can do if someone is going into cardiac arrest. The Heimlich maneuver will also be shown.

Their time in Ruidoso ends August 14, giving Briones, Ocksrider and Zemkova just enough time to return to Albuquerque for the beginning of the fall semester.

"I told Dr. Otero that I'm sad that I only have two weeks," Briones said. "I can't imagine, given this short period of time, how much I've learned. He said that I can always come back and work here. I definitely can see myself practicing here. Ruidoso is a place you definitely want to keep coming back to."